Fri., 10/17/08 Geriatrics/Reconstruction, Paper #37, 4:12 pm OTA-2008
Does Lateral Wall Fracture or Femoral Neck Shortening Affect Long-Term Outcome in Unstable Pertrochanteric Hip Fractures in the Elderly?
Timothy J. S. Chesser, MD (a-Stryker); David Copas, MD (n); Rebecca Fox (n);
Tristan M. Barton, MD (n); Claire Topliss, MD (n); Robert Gleeson, MD (n); William J. Harries, MD (n);
Department of Orthopaedic Trauma, Frenchay Hospital, North Bristol NHS Trust, Bristol, United Kingdom
Purpose: Recent reports have suggested that unstable pertrochanteric hip fractures with either lateral wall fractures or subsequent shortening can lead to worse outcome. This is felt to be secondary to a decrease in the moment arm of the abductor muscles of the hip. This study aims to assess functional outcome against this hypothesis.
Methods: A cohort of 108 patients with follow-up who sustained unstable pertrochanteric fractures (OTA 31 A2) were entered into a separate randomized trial between treatment with either a long gamma nail (LGN) or sliding hip screw (SHS), and prospectively studied. Presence of a lateral wall fracture and the degree of shortening were assessed with serial radiographs at 3, 6, and 12 months. Functional outcome was assessed using a mobility score and EuroQoL. Statistical analysis was performed with the help of a medical statistician.
Results: All patients were followed up. The LGN group’s mean age was 81 years (range, 40-94). Mean follow-up was 10 months (range, 3-24). There was a 17.4% incidence of lateral wall fracture. Mean femoral neck shortening was 8.3 mm (range, 0-35.7). Mean age in the SHS group was 83 years (range, 66-97). Mean follow-up was 11 months (range, 3-24). There was a 12.2% incidence of lateral wall fracture. The average length of shortening was 21.2 mm (range, 2.1-48.5). The loss of offset and leg length between the two groups was statistically significant (P < 0.05). Collapse was found to be a statistically significant predictor of quality of life as measured by the EuroQoL at final follow-up. There was no correlation with length of stay. There was no correlation with outcome (length of stay and EuroQoL values) associated with the presence of a lateral wall fracture.
Conclusion: The occurrence of lateral wall fractures did not affect the long-term functional outcome in these patients suffering unstable pertrochanteric fractures. Collapse was found to be a predictor for quality of life with the greater degree of collapse, the lower the quality of life.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.